Mind the gap! | Liu Chun-Hao, Abucastor | TEDxNCU

The Lanyu , also named Orchid Island, was found higher prevalence of psychosis. Through personal observations, coupled with comprehensive data, Dr. Liu reminded that prevalence of the disease may come from social issues.

Liu is a psychiatrist. His medical practicing journal was published in 2013. Next, he joined the "Taiwan Medical Mission" heading to Swaziland for practicing medicine services.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

I'm a psychiatrist.

I wonder what pops in your mind
of a psychiatrist?

The common impressions are that

they tie people up in mental houses
to give a needle shot?

Or sitting on the opposite end of a desk

saying: " You are absolutely right!"

"I wonder what you're thinking?"

"Look on the bright side.
Don’t kill yourself."

I wonder which one it is.

Being a psychiatrist,

we must return to basic principles.

A psychiatrist is dealing
with mental issues

and aspects on physiology,
psychology and society.

You might ask: "what does psychology
have to do with physiology and society?"

Take an example of mental disease.

Schizophrenia, a mental disorder,

is known as split or multiple identities.

Some are paranoid with hallucination,

often saying things of nonsense

or behaving weirdly.

This kind of disease is unique.

Its prevalence around the world
is one percent.

Yet we know that this disease
is hereditary,

meaning that if one of your parents

or siblings is schizophrenic,

then your lifetime prevalence
will rise to 10%.

If your identical twin is a schizophrenic,

then your lifetime prevalence
will be 50%.

Besides it is hereditary,

basic and clinical research tells us that

schizophrenia is caused
by mental problems,

and will also become severe
physiological problems.

We know that the lack
of neurotransmitters

in the brain, dopamine,

is the main cause for the disease.

It is just like Myocardial infarction,
a heart disease;

and kidney failure, a kidney illness.

Some say that Schizophrenia
is a brain disease.

Can this explain for all cases?

Here is an example.
This is Lanyu.

Research suggests
that schizophrenia prevalence

is 3 times the main island of Taiwan.

Quite strange!

Isn't schizophrenia roughly
of the same prevalence around the world?

Why is Lanyu 3 times?

Remember that I said this disease
is highly hereditary.

Is it possible that gene

was passed on between
generations on the little island,

causing its high prevalence?

Here's another observation.

If we review the documentary,

the research conducted
by anthropologists in the 1960s,

suggested none diagnosed
as schizophrenia.

In the 1980s,

The doctors on site reported

only 2 to 4 patients.

However, starting from 1992,

the doctors from Mackay Memorial Hospital

found that the mental patients
were on a rise,

climbing to 50 in 2004,
reaching 58 in 2005, and 66 in 2009.

If you ask in detail
how their disease progress,

you will find something peculiar -

over half of the patients
started to show symptoms

when they were in Taiwan.

Strangely, how is such connection
between Taiwan and Lanyu?

Actually, we know that in the 1970s
Lanyu was a restricted mountain area.

There wasn't much interconnection
in between.

After 1971 to 1973, there appeared
regular flights between the two islands

and this lifted the restrictions.

The people of Lanyu could
freely go to Taiwan and vice versa.

We found that among these
66 mental patients,

their demography is distributed
between 25 to 60.

Very few were above 60.

If you push the axis back,

you will see these people
approaching post-adolescence

have gone through major social shock
to alter their own lives.

Over half of these people share
the same story.

They grew up at the village in Lanyu.

After leaving school,
they looked for jobs.

Becasue of no job locally,

they went to Taiwan for work or study.

Coming to a new environment
with no acquaintances

led to the pressure of migration.

Furthermore, in their hometown

they could be a good fisherman,

capable of building canoes

but in main island, they are nothing.

Their social structure disappeared,

family function was deconstructed,

and self-recognition had collapsed.

This led to issues of alcoholism.

Some were suffering psychiatric symptoms

and then sent back to Lanyu.

Apart from Schizophrenia,
the abuse of materials,

in particular, the alcohol

is a major domain in psychology.

According to anthropologists' survey,

there wasn't a alcohol culture
in the tribe of Lanyu.

We don't know why their ancestors,

when migrating from
Batan islands of Philippines,

did not bring wine-making
culture to Lanyu.

So, there is no wine in their culture.

But starting from the yeat 1971,

the wine consumption,

soared, regardless of quantity or cost.

I have told two stories -

about schizophrenia,

and "abuse of material", respectively.

Both are linked to society.

But you might say

that it's special because
it's psychiatric disorders.

Well, one disease
unrelated to psychology is -

HIV, the AIDS disease.

AIDS basically is not psychiatry.

It's a infectious disease.

Before being a psychiatrist,

I had been to Africa twice
for medical practice.

The first trip was Swaziland
located in the Southern Africa.

The second one was Ghana
in the Western Africa.

Swaziland has

the highest prevalence
of AIDS in the world,

and the lowest
average life expectancy.

30 to 40% of the population

are infected with the HIV virus.

It was a common scene
in the medical wards where

a young patient was lying
on a hospital bed

feeling weak from the fever.

We supposed the black spots on his face

are probably the Kaposi's sarcoma.

He must be an AIDS patient
in terminal stage .

I asked his family,

"What happened to him,
how did he end up this way?"

They replied,

"This young man originally
grew up in our village.

When he attained adulthood,

he couldn't find a job in the village.

So, he went to the city for jobs.

After four to five years,

he returned looking like this.

As for infectious diseases,
there are two elements:

one is source of infection,
the other is a route of transmission.

Now we know that AIDS is unlike SARS

which is easy to spread.

AIDS is infected through
contact with body fluids.

Swaziland is a country with many hills.

their residential housing
is scattered communities.

It is far away between each
of housing unit or village.

Under these geographical circumstances,

how did AIDS spread so quickly
through the country?

How did it become one
of the major problems in Swaziland?

One day I asked the driver
that drove us around town,

"How much does our medical team
pay you per month?"

"About 5000 NTD," he replied.

The commodity prices
in Swaziland aren't low.

A 300 mL Coke costs about 20 NTD,

which is almost the same in Taiwan.

You can hardly feed yourself
with 5000 NTD,

let alone a whole family.

A salary of 5000 NTD

could be enough in a traditional
or agricultural society.

He may live by self-contained
produce from the land.

However in a society of monetary economy,
or economies of scale

all goods put on shelves in stores are

labeled with a price.

The only way to acquire these commodities

is to buy it with earned money.

But can they earn enough?

It's very difficult to be enough.

So it prompts him
to leave their own village,

move to the big city

and find part time jobs there.

After leaving his own social bonds,

leaving his own family,

they are not integrated into the big city,

and become the marginal man.

Marginal men bunch up in cities.

Whether it is drugs, alcohol,
or sexually transmitted disease,

it all originates here.

So they return to their village
with these evil habits,

and evil habits spread out.

Afterwards, I went to Ghana.

It was a completely different scene.

The shopping mall in the picture,
as big as Carrefour,

is hardly seen in Ghana.

The most common scene in Ghana

is like this picture -
their second biggest city.

Their most bustling area
is full of shopping stalls,

which you can't find in Swaziland.

You might find
a fancy restaurant in Swaziland,

but in Ghana, all you can see is stalls.

Besides, you might see
superior cars, Alpha Romeo

But in Ghana, you see a Nissan

or a Hyundai,

even used as a pick-up truck.

You can see it carrying
a bunch of bananas.

Ghana gives the feeling
that every family seems to have a farm,

and run a small business.

It may not generate a huge amount of GDP,

or exports on a large economic scale,

but at least, it is enough
to feed themselves.

Look at comparison of AIDS prevalence.

Ghana is 3%.

Swaziland is 10 times their rate,
ranging between 25~30.

Their Human Development Index
is approximately the same.

A contrast exists in the wealth gaps.

Ghana is at 61st place,
Swaziland comes in 19th place.

The top three countries are

Lesotho, South Africa, and Botswana.

If you are unfamiliar
with these countries,

check this map.

It just happens that these countries

are the highest HIV prevalence
in the world.

The UN reported on the wealth gap

that even in developed countries

such as Europe, America, Japan,

the higher the wealth gap,

the severer the problems.

Other than the criminal rate
and literacy rate,

social problem related
to the medical is life expectancy.

and the the ratio of psychiatric patients.

I've seen this often.

This picture intrigues me,

because our medical station in Ghana

was in a remote village

without tap water.

You would see this scene

that lots of children, after school
time, retrieve water at the river,

carry the buckets on the head
and walk in a line back home.

What I saw were
smiles on their faces.

The smiles were seldom seen in Swaziland,

You can hardly see the young
in rural areas of Swaziland.

You can see them drinking on the roadside,

or sometimes drinking in bars.

This is just my observations,

not a sample from statistics.

but I sure see big difference
between two countries.

If you hop on a subway,

you will hear, ”Mind The Gap.“

Be careful of the gap on the platform.

Actually there are lots of little things
that we don't even notice.

You can't see the gaps.

You could say that

these gaps make people across
this gap feel like strangers.

These AIDS patients

these drug addicts, alcoholics

deserve it!

They don't keep their nose clean.

If you bravely step away from the gap,

putting these problems
in the same vein of society,

their meanings will emerge.

Once you cross this gap,

diseases are no longer just diseases.

It's big social problems behind the scene.

So I leave you with this -

"Mind the gap."
Thank you!